autistic 18 year old has hurt his leg - any health professionals around?

[LaBelleSauvage123]

DS2 had a seizure this morning and collapsed in our small downstairs toilet. When we found him he was in a heap with his legs under him. He slept for an hour and when he got up we noticed he was limping on his left leg. He can weight bear to a certain extent but is hobbling with his left foot turned right out. There's no swelling or obvious injury.

DS is only minimally verbal and has a high pain threshold. If he's still limping tomorrow we will take him to our local MIU but there are all sorts of potential issues with this: refusing to be examined, having to wait, not wearing a mask or letting us wear one. DH and I will both have to go with him as he needs 2:1 support in high stress situations. His behaviour can become aggressive when he's distressed.

SO - I know it's impossible to diagnose over the internet, but can anyone tell me what type of injury a limp with foot turned right out might signify? It would help if I had some idea as it would save time, which is of the essence in these types of situations!

Foot turned right out sounds like a broken hip, but as he’s walking I assume not.
I dont think it would do any harm to phone 111 for advice.

When I say hip, it’s actually the top of the femur that breaks. If it’s turned right out I would be concerned.

I had a broken tib/fib ankle dislocation and my foot was pointing in the wrong direction. Impossible to ignore though so I doubt it’s that as it was a result of severe trauma. I’d call 111.

His feet turn out anyway as he has hypermobile ankles but its more extreme than usual.

Fingers crossed it’s minor. If he will allow you to touch him is there anywhere that hurts more than another? If it is the hip area please go to hospital/MIU sooner rather than later.

I have a high pain threshold due to disability and could limp on a broken hip. I did for a day because A&E/radiology missed it on X-ray. It is serious if it may be - I was told it could have dislocated and after the second X-ray they didn’t want me to walk (went on on one crutch).

I’m sure second nature to you now but remind them about the pain threshold - junior doctor said it wasn’t anything serious, thought I’d be crying/screaming walking on it if it was broken.

I agree with PPs that you may be dealing with a hip injury/break. I have a former client who walked around with a broken hip for a week before his family took him to the hospital.

I really feel for you - my twins are only 4, both autistic and I absolutely dread things like this because they just don’t understand and they too have a high pain threshold. Does he have a care passport for the hospital? We realised after a recent admission that we don’t have one and need to sort one out - luckily the staff were amazing but that’s not always the case!

Can you call the MIU ahead and see if there’s anything they can put in place to make things easier (eg. Making an appointment, coming at a set time and bypassing the waiting room etc). Given that it could be his hip I would err on the side of caution and consider A&E, should be reasonably quiet at night with pubs closed!

I'm going to look and have a feel when he's in the bath later. If it seems that the hip area is sore I'll call 111. Will definitely call ahead to the MIU tomorrow and take his hospital passport with us. When he was 5 he walked in from the school playground on a badly broken leg, so I'm not ruling anything out! But going to A&E tonight would be an absolute nightmare and best avoided if at all possible.

Feel the very top of his leg too.

My son fractured his hip in a footie match and got up to try and play some more before limping off! Wish I g you the best of luck

Oh I really hope he’s okay. Hip injuries can be really serious I think so hopefully it’s not that. It’s so hard when they don’t respond typically to pain - my twins fall all the time but we’ve only had one A&E trip (DT1 cut his eyebrow open and didn’t make a peep). I have this terrible fear that one day they’ll need an X-ray and there’ll be healed fractures or something! I really hope it’s nothing serious

Absolutely emphasise the atypical response to pain - some medical professionals can brush it off and think it can’t be that bad of an injury if they’re not screaming in pain. Been there before with DS2. He fell once and cracked his head so hard his eyes rolled and he vomited. He had concussion but never cried once until the dr refused to give him his stethoscope! Same when he had blood sugars checked with the finger prick test. Didn’t cry, in fact he smiled and asked the dr to do the other 9 fingers 🤦‍♀️. Does sound like a hip injury - I’d phone MIU and see what they can do to facilitate getting him seen without waiting around

Maybe ask to speak to the Learning disability liaison team. If things could get difficult, you could ask them if the positive behaviour management team can support/offer advice. Good luck.

Thanks everyone. I’m not sure our local MIU has a learning disabilities team, but will check. Will update tomorrow.

How is he this morning OP ?

Well - this morning the limp had almost disappeared! Still favouring the right leg a bit, but running around and in a good mood, so took him to school as usual. However they’ve just rung to say he’s ‘grumpy and seems a bit disoriented’ so DH has gone to pick him up. Leg not mentioned but he refused to go on his usual walk round the school field, so will see what he’s like when he comes home.

One thing I forgot until this morning is that he developed a very similar limp about 4 years ago which was assessed by a physio as ‘Pateo-femoral pain syndrome’ and linked to his hyper mobility. So I’m wondering if this could be the same. The remedy last time was specific exercises and a limit on weight bearing activity ( easier said than done!)

Sounds like he definitely needs looking at.